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Indian Journal of Forensic Medicine & Toxicology

Drug Abuse an International Problem: A short review with special reference to African Continent

Author(s): Parul Lakhanpal, Arun Kumar Agnihotri

Vol. 1, No. 1 (2007-07 - 2007-12)

Print-ISSN: 0973-9122; Electronic-ISSN: 0972 9130;

Parul Lakhanpal(1) and Arun Kumar Agnihotri(2)

(1)Reader, Department of Pharmacology
(2)Reader, Department of Forensic Medicine and Toxicology SSR Medical College, Mauritius

ABSTRACT:

Drug abuse is rapidly growing worldwide problem. The problem of drug abuse poses a significant threat to the health, social and economic fabric of families, communities and nations. Almost every country in the world is affected from drug abuse. The problem of drug abuse has now crossed national, ethnic, religious and gender lines also. Today the problems of Global increase of drug abuse reflect and contribute to both the national as well as international tensions. The high level of drug abuse has brought problems such as increase in violence and crime, increase in HIV/AIDS diseases, and collapse in the social structure. The Republic of Mauritius in spite of its size and geographical location has not been spared from the evil consequences of this scourge. Cannabis is the only illicit substance primarily cultivated in the sugar cane fields. Despite of this the maximally abused substance in this country is Heroin. This review article presents the demographical variations of drug abuse, with more emphasis on African continent. We shall also present the hazards of drug abuse and its prevention strategies.

KEY WORDS: Drug abuse, Scenario, Problem, Prevention, African continent

INTRODUCTION:

Drug abuse is the use of a mind-altering drug without medical need, in an amount large enough or over a period longs enough to threaten the quality of life or health and safety of the user or others. Taking a drug that does not usually alter the mind is still considered abusive if the drug is taken without medical need and if the drug endangers the quality of life or health and safety of the user or others. Hence Drug abuse is defined as “excessive or inappropriate use of a psychoactive substance by a person; such use being considered or judged to be illegal (immoral) by the culture and resulting in harm to the person or society”.1

Drugs that are misused fall into three main groups2:

STIMULANTS:

Cocaine, amphetamine and amphetamine related compounds are the main drugs in this group. Cocaine is derived from the leaves of coca plant- Erythroxylon Coca, which is found in Peru and Bolivia. Cocaine may be snorted as a snuff (snow) or injected. Amphetamine and its related compounds (also known as speed) – methyl-amphetamine, dextro-amphetamine and methylphenidate (Ritalin) stimulate the brain and suppress the appetite. They are widely used as peppills and more superficially for the treatment of depression and obesity.

DEPRESSANTS:

This group constitutes mainly the narcotic analgesics- heroin, morphine, pethidine, methadone, etc. and the barbiturates. Opium (the dried juice from the unripe poppy seed capsule) has been known for many centuries and in some societies it was used socially as is alcohol today.

DRUGS ALTERING THE SENSES:

The main drugs in this group are cannabis, LSD (Lysergic Acid Diethylamide) and ‘magic mushrooms’ (Psilocybe semilanceata that contains psilocin and psilocybin). Phencyclidine (PCP, angel dust) is a relatively new drug of abuse but has rapidly become a major problem in USA.Drugs are sometimes divided into two categories – “Soft drugs” and “Hard drugs”.3 Hard drugs are “non-metabolizable” drugs. Hence hard drugs or hard compounds can be defined as compounds which do not degrade in the environment or do it very slowly. The common examples of drugs used by abusers are cocaine, heroin, morphine, pethidine, amphetamine, alcohol and nicotine. Soft dugs or soft compounds can be defined as biologically active compounds which are readily degraded into nontoxic and biologically inactive degradation products in the environment.

Cannabis, mescaline, psilocybin, and LSD are common examples of Soft drugs. Not all drugs fit “Gateway drugs” is a term for drugs that supposedly lead to abuse of other substances. The term gateway drug is used to describe a lower classed drug that can lead to the use of “harder”, more dangerous drugs. This is in fact a controversial concept that using one “soft” non- or only slightly addictive drug will lead to the use of other “harder” drugs, the first drug used is thus described as a gateway to further abuse. Tobacco, alcohol and marijuana are considered gateway drugs. The use of Tobacco, alcohol and marijuana start a progression on to the use of illegal drugs like cocaine regardless of the age, sex, ethnicity or race of the individuals involved.6 NIDA researchers have found that craving for nicotine also increases craving for illicit drugs among drug abusers who smoke tobacco.7,8

Table 1: The WHO classification of drugs of abuse

Drugs type Psychological
dependence
Physical
dependence
Tolerance
Alcohol Mild to marked Mild to marked Some
Barbiturate and
certain other
sedatives
Mild to marked Mild to marked Substantial
Opiate (morphine) Moderate to
marked
Marked Marked
Cocaine Mild to marked None None
Amphetamine and
certain other
stimulants
Mild to marked Little, if any Marked
Khat Mild to moderate Little, if any Little, if any
Hallucinogen (LSD) Mild to moderate None May be marked
with some agents
Cannabis (marijuana) Mild to moderate Little, if any Probable some at
higher doses
Volatile solvent
(inhalant)
Mild to moderate Little, if any Some with certain
agents

GLOBAL PROBLEM:

Drug abuse is a global phenomenon. Although its dimensions and characteristics vary from country to country, almost all the countries in the world are affected from narcotic drugs. In the past few decades, drug abuse among the youth has shown a serious increase. The high level of drug abuse has brought problems such as increase in violence and crime, increase in HIV/AIDS diseases, and collapse in the social structure. Although statistics reveal that some parts of the society use drugs more extensively, drug addiction can come out from any part of the society. For example, men use more drugs compared to women, married people use more drugs compared to single ones, people living in the city use more drugs compared to people living in the country, youngsters use more drugs compared to older ones. Drug of abuse poses a significant threat to the health, social and economic fabric of families, communities and nations. The situation of drug abuse varies from region to region and from country to country. According to the World Drug Report published by the UNDCP9, a total of 180 million people abuse drugs worldwide. Globally cannabis is probably the most widespread and commonly used illicit drug.

CANNABIS

(Hashish) is the most commonly abused drug with 141 million users. That figure corresponds to 2.25 % of the world population.9 Prevalence rates of cannabis use among young people in the United States have continued to rise since the early 1990s. In western European countries data suggest that rates of cannabis use are generally lower than those reported in the United States, Australia and Canada. Reported prevalence rates of cannabis use in some northern European countries are lower. Cannabis use is reported at lower levels in developing countries, although data from many developing countries is limited. Studies in India have shown lifetime prevalence of cannabis use of 3%10. Lifetime prevalence of cannabis use in Rajasthan (India) among males was higher (7.2%)10. WHO has recently reviewed and summarized knowledge about cannabis use and health effects11.

In the recent years increased use of opiates is being experienced in the West European and Central Asian countries. In Asia, there are two main illicit opium producing areas- “Golden Triangle” and Golden Crescent” (Figure 1).12 The Golden Triangle is an area of around 350,000 square kilometers that overlap the mountains of four countries of Southeast Asia: Myanmar (Burma), Laos, Vietnam, and Thailand. The Golden Crescent is one of the most extensive opium producing areas of Asia which includes Afghanistan, Iran and Pakistan. The available evidence shows that there has been a global increase in the production, transportation and consumption of opioids, mainly heroin13-15. Heroin use has become increasingly common in North-America and Europe since the 1960’s. The abuse of heroin is less widespread when compared to other drugs. UNDCP estimates that 8 million people worldwide are consuming opium based narcotic drugs, with the majority being in Europe, South and Western Asia which is about 2% of the population. The estimated world-wide production of heroin has been more than doubled or even tripled since 198513,15. Evidence from national surveys and other data sources suggests that in Europe heroin injectors, who regularly consume large amounts of different drugs, face a risk of death which may be 20 or 30 times higher than non-drug users in the same age16. Since heroin is commonly used by injecting, the health risks including that of HIV and hepatitis transmission are substantial.

Figure 1: Golden Triangle and Golden Crescent

COCAINE

is most popular drug of abuse in the countries of the American continent and very limited in Asia17. According to the UNDCP reports, 13 million people are using cocaine worldwide18. The use of synthetic drugs, especially ATS (Amphetamine Type Stimulants) is also displaying a very rapid increase. About 30 million people worldwide are using stimulants. Compared to the 1980’s, the use of ATS has shown a rapid increase especially in Europe, the North America and the Southeast Asia in the 90’s19. On the other hand Ecstasy (MDMA) has become the most abused synthetic drug of the industrialized world. The dynamic growth in the use of the MDA-type drugs (including MDMA “ecstasy”) is a particular problem in some European countries and in Australia. Typically lifetime prevalence of ATS use in these countries ranges from 1-3% of the adult population. Prevalence is higher in specific populations in some countries. Among 16-29 year olds in the United Kingdom rates of 14% for amphetamine and 6% for MDMA have been reported19.

TOBACCO, ALCOHOL AND ILLICIT DRUGS

contributed altogether 12.4% of all deaths worldwide in the year 2000. Out of which illicit drugs alone contributed around 0.4% of deaths. Tobacco continues to be the substance causing the maximum health damage globally (WHO, 1995)20. According to WHO estimates, there are around 1.1 thousand million smokers in the world. Tobacco is estimated to have caused around three million deaths per year in the early 1990s, and the death toll is steadily increasing. Unless current trends are reversed, that figure is expected to rise to 10 million deaths per year by the 2020’s or the early 2030 (by the time the young smokers of today reach middle and older ages), with 70% of those deaths occurring in developing countries20. The disease burden in Disability Adjusted Life Years (DALYs) is significantly higher in Europe and the Western Pacific than in Africa and the Eastern Mediterranean. Also the share of the burden for the different substances varies; tobacco is the largest burden in Europe and South-East Asia while alcohol poses the largest burden in Africa, the Americas, and Western Pacific21. Between 1970 and 1980 alcohol consumption increased by about 3.6% world wide. However, it increased by 22% in Asian countries where alcohol is not used traditionally22. The extent of worldwide psychoactive substance use is estimated at 2 billion alcohol users, 1.3 billion smokers and 185 million drug users.

SCENARIO IN AFRICAN CONTINENT:

During the past fifteen years, Africa has become a revolving door and a major centre of consumption for the drug trade. The main drugs of abuse or so-called ‘danger drugs’ are marijuana also known as dagga or ganja, cocaine, heroin and a number of other synthetic narcotics for instance amphetamines and the hallucinogen LSD and methaqualone (‘Mandrax’)23,24. An estimated 32 million Africans abuse illicit drugs. Cannabis remains the most widely abused drug (27 million). Approximately 5 million Africans are the abusers of heroin, opiates, cocaine, and psychotropic substances25. The use of cannabis has been more prevalent in North Africa and southern Africa but appears to be less abused in countries of east Africa, such as Ethiopia and Somalia, where the abuse of khat is prevalent. The chewing of khat has been practiced for years and is socially accepted in Ethiopia, Kenya, Madagascar and Somalia. It is mainly used by students to improve their academic performance, by truck drivers to keep themselves awake and by laborers to supply the extra energy they need for their work.26

Seizures of cannabis have been made in many African countries including: Algeria, Kenya, Lesotho, Malawi, Morocco, Nigeria, Senegal and South Africa27. In some northern and sub-Saharan African countries (e.g. Egypt, Kenya, Morocco, Nigeria and Tanzania), there is a long tradition of cannabis use for culinary, medicinal and ceremonial purposes28. Data from Nigeria show that 7% of university students had ever used cannabis and lower rates are reported in the general population28.

The abuse of amphetamines in Africa is also a problem mainly among adolescents and unskilled labourers, such as drivers and farmers and the prevalence rate of Amphetamine and amphetamine like substances is 0.5%. Mandrax (methaqualone and diphenhydramine) was commonly abused in Nigeria in the early 1970’s, but since it was banned, its abuse has abated. However, some other African countries, such as Swaziland, have reported an increase in the trafficking and abuse of Mandrax. Recent reports from Kenya, Somalia, SwaziIand and Zambia indicate the abuse of glue and petrol by sniffing, though the extent of such abuse varies from country to country.29

The drugs of abuse in South Africa can be divided into three categories, extensively used, moderately used, and less frequently used30. In the category of extensively used drugs, alcohol remains the most commonly abused drug followed by dagga (cannabis), Mandrax (Methaqualone) and the dagga/Mandrax (white pipe) combination. In addition to these drugs, there is also considerable abuse of over-the-counter and prescription medicines like pain relievers, tranquillizers (including benzodiazepines), cough mixtures (containing codeine), and slimming tablets) and solvents (especially glue). In moderately used drugs crack cocaine, cocaine (powder), heroin, Speed, LSD, hashish and Ecstasy (MDMA) are included. Less frequently used drugs are opium, Rohypnol (Flunitrazipam), Ketamine, and Wellconal. However in terms of pharmacological properties, the substances most abused in South Africa are depressants (e.g. alcohol, white pipes, Mandrax, benzodiazepines) followed by hallucinogens (dagga, LSD, Speed and Ecstasy). In a survey of 1378 African young persons aged 10-21 from urban and rural areas of South Africa, Rocha-Silva et al31 found that apart from Dagga (5.5%), the use of various other illicit substances was as follows: LSD (1.9%), Mandrax (1.7%), cocaine (0.9%), heroin (0.9%), Ecstasy (0.1%), nonprescriptive narcotics other than heroin (2.1%), and steroids (2.0%). In the Cape Province of South Africa a survey conducted in 1990 found that 7.5% of high school students had ever smoked cannabis32.

The Republic of Mauritius is located in the Indian Ocean with an area of 1865 sq km. It is situated 900 km east of Madagascar. In 2002, the population of the Republic of Mauritius was 1,193,737 with 595,067 males and 598,130 females (Government of Mauritius, 2002). The Republic of Mauritius in spite of its size and geographical location has not been spared from the evil consequences of this scourge. The consequences and the burden of harm on the individual, the family and society are manifold. The abuse of illicit drugs in the island has over the past decade increased significantly. The main drugs abuse among persons in drug treatment is Brown Sugar, heroin, cannabis and psychotropic drugs. Prior to the 1980’s, drug abuse in Mauritius consisted mainly of locally grown cannabis. Cannabis is the only known illegal substance cultivated in the country. According to Police, cannabis is cultivated illegally in sugar cane fields, in remote and inaccessible areas of mountains, river banks and in forest especially in the South West region of the island as well as in private yards in flower pots and plastic bags. Beginning in the early 1980’s, the ‘brown sugar’ unrefined form of heroin was introduced into the urban and periurban regions of the island, and was used predominantly by adult males through inhalation, known as ‘chasing the dragon.’33,34 According to drug abusers, a new substance has been introduced on the market during the past year. It is referred to as “La Dame Blanche” or “White Lady” and is being increasingly used by drug abusers. Alcohol, however, is widely used and abused in the country. Availability of illicit drugs is more predominant in peripherals of urban regions as well as in localities where the level of poverty is high. Treatment Centers have noticed that the age of initiation to use and abuse of drug is as low as 11 to 13 years old and that an increasing number of women are also using drugs. According to the MENDU (Mauritius Epidemiology Network on Drug Use), data collected from treatment centers from July to December 2003 indicates that heroin is commonest substance used by abusers (Table 2)33.

The demographic profile of the drug abusers shows that an educated employed male with a mean age of 34 yrs (age ranges from 30 to 44 years) is most commonly involved in abusing illicit substances. Approximately 86.4% of the drug abusers started using drugs in their teens. About 48% of drug abusers were consuming drugs by injection. Among these, 45% of abusers share needles. Almost 100% of them were tested positive for Hepatitis C33. Nowdays, injection drug use has become the main mode of HIV transmission. The data from a 2004 rapid assessment of drug use in Mauritius, and from the Mauritius Epidemiological Network on Drug Use, the AIDS Unit at Ministry of Health; and the Mauritius Prison Service showed that there are an estimated 17,000-18,000 injection drug users (IDUs) (i.e. 50% of total drug users) in Mauritius of whom 4,800 are commercial sex workers and 2,871 are prisoners. Prevalence of needle sharing among IDUs is estimated at 25-50%, and 75-90% of IDUs report using condoms “seldom” or “never.”34

Cannabis is also reported to be cultivated in the island of Rodrigues. In Rodrigues, the increase in prevalence of cannabis use is given to be higher, followed closely by alcohol abuse. There is, however, an insignificant prevalence of heroin use.

HEALTH AND SOCIAL CONSEQUENCES OF DRUG ABUSE:

The negative consequences of drug abuse affect not only individuals who abuse drugs but also their families and friends, various businesses, and government resources. Substance abuse and addiction have grave consequences on our existing social systems, effecting crime rates, hospitalizations, child abuse and neglect, and rapidly consuming limited public funds35.

But the most commonly affected fields are:

Table 2: Illicit Substances used by Drug Abusers33

Illicit Substances Percentage (%)
Heroin 40.9
Alcohol 36.7
White lady 12.5
Miscellaneous (cannabis, Opioids,
psychotropic drugs, etc.)
09.9

A. FAMILY AND COMMUNITY

The disintegration of the family appears to be related, in some way to the problems of substance abuse. Study carried out by United Nations Research Institute for Social Development (UNRISD) and United Nations University on Mexico, show that illicit drug abuse correlates more strongly with the disintegration of the family than with poverty36.

Many studies so far have confirmed direct association between the consumption of illicit drugs and the breakdown in the family bond. Country study on the Lao People’s Democratic Republic and on Thailand attribute increasing use of heroin, opium and psychotropic substances to urbanization, rapid cultural change and a breakdown in family cohesion.37,38 The substance abuse strains the family relationships and ultimately makes the families dysfunctional and transforms them from an asset of society into a burden. Family factors like prolonged or traumatic parental absence, harsh discipline, and failure to communicate on an emotional level are usually thought or lead to, or intensify, drug abuse. While the family itself can be the source of drug problems, it can also be a potent force for prevention and treatment. There has been increased acceptance of family therapy, where more than one member of the family is involved simultaneously in therapy sessions.

HEALTH

The negative impact of drug abuse on health is obvious, scientifically established and documented in an extensive literature which is beyond the scope of the present report. The most obvious effects of drug abuse—which are manifested in the individuals who abuse drugs—include ill health, sickness and, ultimately, death. Over 28 million Americans have admitted to abusing a substance in the last year alone35.

The substances most commonly associated with drug-related deaths are heroin, opiates, cocaine, and, to a lesser extent, barbiturates and amphetamine- type stimulants, notably methamphetamine. Depending on the dosage, different substances such as benzodiazepines, hallucinogens and cannabis have different negative impacts on health. These substances do not usually cause death directly but they may be associated with fatal accidents. Cannabis-associated psychosis has been reported to be between 12 and 40 per cent of all psychosis in African psychiatric hospitals39. About a quarter of all deaths in the United States—are caused by addictive substances: 105,000 from alcohol abuse, 446,000 from tobacco use, and 39,000 from addictive drugs in 1995. The magnitude of addiction’s impact on morbidity is also great, causing approximately 40 million illnesses and injuries each year40.

Injection drug use (IDU) is becoming an increasingly important mode of HIV transmission globally. The number of drug-related deaths of injecting drug users (IDUs) amount to a maximum of 200,000 cases per annum globally. Given an estimated global drug-injecting population of 5.3 million in the early 1990’s, the ratio of drug-related death to drug-injecting population, using the estimate of 200,000 deaths of IDUs, would be some 0.4 per cent41.

From the mid-1980s to the early 1990s cases of SARM (substance abuse related mortality) increased by a factor of 6 in Germany and Spain, and a factor of approximately 5 in Austria, Belgium, Italy and Switzerland. In France and the United Kingdom, SARM cases only doubled, but, in contrast to most other European countries, they continued to grow in the 1990’s. SARM cases in the Netherlands fluctuated but remained around the same level. Reports from the Russian Federation suggest that SARM increased by a factor of 4 in the early 1990s to more than 2,000 in 1992, making the Russian Federation the country with the world’s second largest SARM rate after the United States. In Poland, SARM increased by about 50 percent between 1989 and 1992. In countries and areas outside Europe, strong increases were reported from, for instance, Hong Kong, Japan and Saudi Arabia.42 However, there was an outbreak in Scotland. In 2000 and 2001 approximately 292 and 332 drug-related deaths were reported in Scotland, respectively43.

The problem of drug abuse primarily and directly affect health and indirectly society; such as by giving rise to higher health-care costs, prostitution, AIDS and many other diseases. This creates additional health dangers for society as a whole.

Some 22 per cent of the world’s HIV/AIDS population is drug injectors. The spread of HIV is well documented in countries in and around the Golden Triangle, such as in Myanmar itself, in China, India, Malaysia, Thailand, Viet Nam and, more recently, in Indonesia.44-49 The majority of reported HIV infections and AIDS cases in 2001 were attributed not to sexual transmission, which is the predominant mode in Africa49.

C. EDUCATION

School children who use drugs often suffer from impairment of short-term memory and other intellectual faculties, impaired tracking ability in sensory and perceptual functions, preoccupation with acquiring drugs, adverse emotional and social development and thus generally impaired classroom performance. Reduced cognitive efficiency leads to poor academic performance and a resulting decrease in self-esteem and the adolescent may eventually drop out altogether. This contributes to instability in an individual’s sense of identity which, in turn, is likely to contribute to further drug consumption, thus creating a vicious circle.

D. CRIME, CORRUPTION AND DANGERS FOR CIVIL SOCIETY

Drugs and crime are related in several ways. Drugs increase the likelihood of many kinds of criminal activity. Long-term trends based on data collected between 1975 and 1989 and presented to the Commission on Crime Prevention and Criminal Justice, show that drug-related crime and robbery were the fastest-growing component in crime as a whole, after kidnapping50.

A review of the relevant literature indicates a strong probability that drug addicts tend to be deeply involved in criminal activities, with daily users of drugs showing a significantly higher rate of criminality than non-drug users51. This has also been confirmed indirectly by the National Crime Victimization Survey of the United States, which revealed that 30 per cent of the victims of violent crime in 1992 perceived their attacker to have been under the influence of drugs or alcohol51.

Drug-related crime and violence is high not only in consumer countries, but also in producer countries, the most striking example of this being Colombia. The Colombian Government clearly sees a link between the narcotics trade and the deaths of many of its citizens over the past two decades52.

With drug cultivation and trafficking booming, the number of killings increased from 17 per 100,000 people in the 1973-1975 period (i.e., before large-scale drug cultivation started) to 63 per 100,000 in 1988, which, at the time, was the third highest murder rate in the world52.

PREVENTION AND CONTROL:

The prevention strategies of the WHO are deeply embedded in the public health approach that encompasses primary, secondary and tertiary prevention, with the aim of helping individuals to adopt healthy practices and life styles, make use of relevant information and skills in order to avoid the use of psychoactive substances, and prevent or minimize the associated health consequences of substance use53.

Primary prevention

aims to prevent or at least delay the initiation of illicit drug use. The focus of this initial stage of prevention is to provide information and educate various target groups within the general population about psycho-active substances and the risks associated with their use. Educational services aim to strengthen individual’s self-esteem and resistance to peer pressure; to promote healthy life styles; to provide a supportive environment and the opportunity to develop life skills. In Mauritius, National Agency for the Treatment and Rehabilitation of Substance Abusers has implicated strategies of primary prevention at the level of school, youth and workplace along with anti-drug education unit33.

Secondary prevention

aims at helping people who are illicit drug abusers to break their habits. It provides drug abusers with educational and counseling services to persuade them to cease experimentation, as well as a range of treatment regimes, followed by rehabilitation programs. It also provides drug abusers with adequate aftercare services in order to sustain drug-free behaviors, prevent relapses and facilitate social reintegration. Secondary prevention should ideally culminate in the drug addict’s return to a drug-free life. In Mauritius, the setting up of the National Prevention Unit by the National Agency for the Treatment and Rehabilitation of Substance Abusers has been highly commended in carrying prevention activities in high risk area in close collaboration with respect to NGOs, Community Leaders and community at large33.

Tertiary Prevention

Aims at reducing the adverse consequences of drug abuse, such as the spread of AIDS. Treatment and Rehabilitation of drug addiction in Mauritius is so far done at NGO level through specialized treatment centers under National Agency for the Treatment and Rehabilitation of Substance Abusers33.

CONCLUSION:

Drug abuse causes multiple problems for countries and communities. The medical and psychological effects are very obvious. Billions of dollars are spent internationally preventing drug use, treating addicts, and fighting drug-related crime. Seeing the rapidly growing problem of drug abuse and their consequences some of the concrete steps are required to weaken the hold of drugs on society. The broad categories of plans decreasing the problem of drug abuse include strategies to reduce the availability of substances, mobilize communities against substance use, provide peer education to prevent taking up substance use, enhance behavior change, strengthen existing networks of organizations that support youth-related activities and engage in substance use prevention activities, and provide community resources including funding for programs on substance use prevention. Private and public sector response to the drug problem in Mauritius has been a combination of supply reduction measures and demand reduction interventions, with a clear bias toward law enforcement. Demand reduction strategies encompass a wide range of awarenessraising campaigns; information, communication and education programs targeting schools, communities and the work place; and free drug treatment and rehabilitation.

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Corresponding Author: Dr. Parul Lakhanpal,
Reader, Department of Pharmacology, SSR Medical College, Belle-Rive, Mauritius,
Email: lakhanpalparul(at)rediffmail.com

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